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There are 26 stand-alone Part D prescription plans available in Arkansas in 2019, with premiums that range from about $17 to $129 per month. Nearly half of all Arkansas Medicare beneficiaries have stand-alone Part D plans.

Medicare enrollment in Arkansas

Medicare was providing coverage for 630,428 Arkansas residents as of December 2018. That’s nearly 21 percent of the state’s population, versus a little more than 18 percent of the total US population enrolled in Medicare.

Most Americans become eligible for Medicare when they turn 65. But Medicare eligibility is also triggered for younger people if they’re disabled and have been receiving disability benefits for 24 months. Nationwide, 16 percent of Medicare beneficiaries are under the age of 65, but 22 percent of Arkansas Medicare beneficiaries are eligible due to disability rather than age. Only three states — Alabama, Kentucky, and Mississippi — have a larger share of disabled Medicare beneficiaries; in all three states, 23 percent of Medicare beneficiaries are under the age of 65.

Medicare Advantage in Arkansas

Private Medicare Advantage plans are an alternative to Original Medicare, and are available in all counties in Arkansas in 2019. Plan availability varies across the state, with just nine plans available in Columbia, Drew, and Lafayette counties, and 31 plans available in Carroll and Pulaski counties.

Only 21 percent of Arkansas Medicare beneficiaries had Advantage plans as of 2017, versus a nationwide average of 33 percent. As of December 2018, there were 154,314 Arkansas residents with private Medicare coverage, while the other 476,114 beneficiaries had coverage under Original Medicare.

Original Medicare coverage is provided directly by the federal government, and enrollees have access to a nationwide network of providers. But people with Original Medicare need supplemental coverage (from an employer-sponsored plan, Medicaid, or privately purchased plans) for things like prescription drugs and out-of-pocket costs (out-of-pocket costs are not capped under Original Medicare).

Original Medicare includes Medicare Parts A and B. Medicare Advantage includes all of the benefits of Medicare Parts A and B, and the plans usually also have additional benefits, such as integrated Part D prescription drug coverage and coverage for things like dental and vision care. But Medicare Advantage insurers establish their own provider networks, which are generally localized and more limited than the nationwide network for Original Medicare. Out-of-pocket costs for Medicare Advantage are often higher than they would be if a beneficiary had Original Medicare plus a Medigap plan. There are pros and cons to either alternative, and no single solution that works for everyone.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). Starting in 2019, people who are already enrolled in Medicare Advantage also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in Arkansas

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had only Original Medicare. According to an AHIP analysis, 178,094 people had Medigap coverage in Arkansas as of 2016. That’s about 37 percent of the state’s Original Medicare beneficiaries (Medigap plans cannot be used with Medicare Advantage plans).

Medigap plans are sold by private insurers, but the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits offered by a particular plan (Plan A, Plan F, etc.) are the same regardless of which insurer sells the plan. Pricing, however, varies from one insurer to another.

But Arkansas is one of just eight states where Medigap premiums cannot vary based on an enrollee’s age (referred to as “no age rating” in Arkansas), as long as the enrollee is at least 65 years old (more on this below). Medigap premiums in Arkansas can still vary based on tobacco use and medical history, with preferred premiums and standard premiums for various scenarios.

There are 35 insurers that offer Medigap plans in Arkansas; three of them also offer Medicare Select plans (Arkansas Blue Cross Blue Shield, United Healthcare, and Sterling Life), and another seven insurers continue to provide Medigap coverage to existing enrollees but are no longer enrolling new members. Medigap insurers in the state are required to maintain minimum loss ratios of at least 65 percent for individual policies, and at least 75 percent for employer group policies. This means that at least 65 percent (or 75 percent for group plans) of the premium revenue that the insurers bring in must be spent on enrollees’ medical claims.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and 22 percent of Arkansas Medicare beneficiaries are under age 65. Federal rules do not guarantee access to Medigap plans for people who are under 65, but the majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans. Arkansas joined them in 2018, with a law that was enacted in 2017 (Act 684). The law called for the Arkansas Insurance Department to amend the state’s rules so that people under age 65 would be able to purchase Medigap coverage, and work out the details by 2018 (prior to that, Medigap insurers in Arkansas did not have to sell plans to people under the age of 65).

In early 2018, the Arkansas Insurance Department announced that as of July 2018, Medigap insurers in the state would have to offer at least one Medigap plan to Medicare beneficiaries under the age of 65. Insurers can pick which plan they want to offer to disabled enrollees, and nearly all of them have chosen Plan A (the least comprehensive Medigap plan), although a couple insurers are offering Plan B. There is no requirement that Arkansas Medigap insurers extend the “no age rating” rule to people under the age of 65, and most of the insurers are charging significantly higher premiums for disabled enrollees.

Disabled Medicare beneficiaries have another Medigap open enrollment period when they turn 65. At that point, they can switch to a plan with the lower premiums that apply to people who are aging into Medicare, rather than qualifying due to disability.

Disabled Medicare beneficiaries can choose instead to enroll in a Medicare Advantage plan, as long as they don’t have kidney failure. Medicare Advantage plans are otherwise available to anyone who is eligible for Medicare, and the premiums are not higher for those under 65. But as noted above, Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $6,700 per year for in-network care, plus the out-of-pocket cost of prescription drugs.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Medicare Part D in Arkansas

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer-sponsored plan need to obtain Medicare Part D in order to have coverage for prescriptions. Part D can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Part D prescription drug coverage.

307,184 Medicare beneficiaries in Arkansas — nearly half of the state’s total Medicare population — had prescription coverage under stand-alone Part D plans as of late 2018. Another 138,274 had Part D prescription coverage integrated with their Medicare Advantage plans.

Medicare spending in Arkansas

Original Medicare’s average per-beneficiary spending in Arkansas was a little lower than the national average in 2016, at $9,304. That figure is based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage. Nationwide, average per-beneficiary Original Medicare spending stood at $9,533.

Medicare spending in Louisiana was the highest in the nation, at $11,399, which was 20 percent higher than the national average. At the other end of the spectrum, per-beneficiary Medicare spending was lowest in Hawaii, at just $6,441.